The eyelids protect and maintain the health of our visual system. They lubricate our eyes bathing tears over the surfaces of our globes countless times a day. The tears provide nutrients, oxygen, disease-fighting antibodies, protective mucus and oils that are all key to the health of our eyes.
At times, a person’s eyelids may become red and irritated, or their eyes may be constantly red, watering and sticky. These conditions can lead to floppy eyelid syndrome (FES) which is often seen in association with obstructive sleep apnea (OSA).
With FES, a patient’s eyelids become very lax and excessively long/loose with time. It is part of a cyclical cause. With OSA, a person snores and stops breathing with sleep. With the cycle of repeated lack of oxygen with sleep, free radicals (rogue particles) form in the body and circulate, attacking tissues and causing inflammation. In the eyelids, these free radicals cause a change in tissue architecture and make the lids less elastic. As the elasticity is lost, the lids become more loose and lax, and easily evert with sleep.
In addition, those with OSA often turn onto their side or stomach to ease snoring which causes their eyelids to rub on their pillow and often flip over due to elasticity. The affected individual is unaware of this occurrence, but will be bothered by constant feelings of irritation and discharge.
The cycle repeats itself and relief is brought about by addressing the underlying cause – the obstructive sleep apnea.
Those suspected of having sleep apnea will be recommended to have a sleep study to confirm the diagnosis. In most cases, a CPAP device will be issued to ensure proper oxygenation is maintained with sleep. Affected individuals are also often advised to lose weight. With enough weight loss, often the OSA will cease, and the ocular complaints will improve and may even reverse themselves. If a person is unable to resolve their OSA, eyelid surgery may help to alleviate ocular symptoms. However, first and foremost, the OSA must be addressed to preserve lung and cardiovascular function. Low levels of oxygen stress both systems and significantly increase the risk of an adverse cardiac event.
So the next time your ophthalmologist asks if you snore, there may very well be a good reason! A recent patient was able to avoid having eyelid surgery after taking action to address his OSA, which can be reversed.
“I was recommended to Dr. Hui for a lazy eyelid,” the patient states. “My initial meeting was met with doubt. Dr. Hui said I had OSA and would not operate until I was evaluated for this condition and tried to lose weight. After some serious thought, I did the sleep study and found I had severe OSA and began using the CPAP machine. Finally sleeping better, I took Dr. Hui’s advice and lost 35 pounds in 6 months. I no longer need CPAP, the eyelid has corrected itself, and my COPD has disappeared. I have great breathing capacity, sleep soundly and regained my energy and health at 71 years old!”
Dr. Hui is the founder of The Eyelid Institute in Palm Desert. She is an Oculoplastic surgeon with a special interest in helping patients with eyelid, lacrimal and orbital conditions and can be reached at (760) 610.2677.